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Outline
•
Orthodontic directions
•
Medical and dental
history
•
Klinical examination
•
Model analysis
•
Angle diagnostic
system
Extraoral examination
(Gummy smile ?, complett or incomplett lip closure)
Glabella
Nose
Chin
Glabella
Nose
Chin
Orthodontic directions
Orthodontic directions
Sagittal (mesiodistal anomalies-Angle
classification)
Vertical (deep bite, open bite)
Transversal (narrow)
Angle Class I.= neutral occlusion
Class I. Cuspid
Angle classification
based on:anteroposterior (sagittal)
relationship of the jaws
==
Class I. doesn’t mean that the denture is perfect (crowding, diasthema,
ectopic teeth, rotated teeth, impaction etc.)
Angle II.= distocclusion
Angle II/1
Overjet
Distocclusion The mandible is usually behind
Sometimes the prognathism of the
upper jaw is also responsible for the
amomaly
Deep bite 70-80 %
Mouth breathing (often)
Incomplett lip closure
Often acquired anomalies
(bad habit, tongue)
Distoocclusion
Overbite (always)
Retrusion of upper incisors
Angle II./2 rendellenességek
jellemzői Hereditary anomaly
Excessive function of
the upper lip
Pronounced sulcus
mentolabialis (deep
bite)
Nose breathing
„Forced distooclusion”
Angle III – progenie - mesiocclusion
CLASS III MALOCCLUSION
Real III. class: macrogenia or
anterior position of the mandible
ANTERIOR CROSSBITE
Pseudoprogeny: when the
maxilla is responsible for
the anomaly (micrognathia)
or early contact of the cups
forses the mandible
forward
The six keys of occlusion
(by Andrews) are:
Molar inter-arch relationship
Mesio-distal crown angulation
Labio-lingual crown inclination
Absence of rotation
Tight contacts
No (or mild) curve of Spee
Angle subdivion - if the occlusion
on the right side and left side are
different
By narrowing of the arches
the lateral cusps forces the
mandible to lateral direction
Sceletal assimetry
III Class
Tongue –thrust swallowing
Lip-pressure swallowing
Thumb sucking
2014.10.07. 35
-Consequences of
thumb sucking
-Open bite
-Protrusion of
upper incisors
-Retrusion of
lower incisors
- Distalocclusion
Mouth breathing the nasal cavity is usually closed(nasal gland, polyp etc.)
Upper incisors are protruded
Open bite
Inflammated marginal gingiva
Mouth breathing
Oral breathing
Measurements
Arch perimeter analysis (place analysis)
Pont- index
Schmuth- index
Moyers- index
Bolton analysis (77,2%)
ISD 75.5%-78,9%
Place analysis
The lower jaw is more important, because
we are not able to increase the size of the
mandible !!!
By space analysis we compare the necessary (calculated) place with the
actual (available) place in the denture.
or extraction
Steiner analysis – place analysis
Width of 3,4,5 Width of 3,4,5
Width of 2,1,1,2
Available place Available place
Available place
Necessary (calculated) value =
Available(measured) value Calculated value Difference
Sum of differences
Factors which influence the space analysis
Straightening Curve of Spee needs 0,5 – 3 mm
.
Factors which influence the space analysis
Position of thef incisors
Position of the incisors
If 1 mm protrusion is possible it means 2mm place-winning
If 1 mm retrusion is necessary it means 2mm loss of place.
Leeway space
The primary molars are smaller than the premolars
In mixed dentition we don’t know the size of the canines and premolars
incisors
Moyers- index
Moyers A 75 %-os valószínűségű eredménnyel számolunk.
Pont- and Schmuth- index
Pont-index
We have to decide how to create place = expansion or extraction ?
The ideal arch width
Pont-Index
If the difference between the optimal premolar, molar distance and the measured premolar, molar distance (on the model) is less then 5 mm EXPANSION
If the difference between the optimal premolar, molar distance and the measured premolar, molar distance (on the model) is more then 8 mm EXTRACTION
Between 5-8 mm BORDERLINE CASE
Modell analysis
Ideal upper anterior length:
SI x 100
160
The optimal length of the lower arch
Is 2 mm shorter than the upper.
Modellanalysis
Schmuth – index
Based on SI
premol.: SI + 8 mm
mol.: SI + 8 + 8 mm
Anterior length of the dental arch SI / 2
Coronal base
Apical base
75.5%-78,9% normal range
89.5%-93,1%, normal range
73
Orthodontic treatment
in primary dentition 1.Progenia
appliance: chin cap
2.Bad habits: thumb sucking,
appl.: oral screen
3.Cleft lip and cleft palate
4.Loss of primary teeth
appl.: space maintenier
5.Crossbite
appl.: inclined plane
Orthodontic treatment in
mixed dentition 1.Crossbite
appl.: inclined plane
2.Early loss of primary teeth
appl.: space maintener
3.Functional jaw orthopedic
Sagittal anomalies: Angle II. – distalocclusion
Angle III. – mesialocclusion
Vertical anomalies: open bite
deep bite
appl.: bimaxillary functional appliances activator,
bionator, Frankel-appl., Hansa-appl. etc.
4.Diasthema medianum
appl.: removable appliance with springs
brackets
5.Crowding with or without lateral crossbite
appl.: expansion of the dental arch with activ removable plates or quad-helix
6. Timing of first molar’s extraction
( reason: gangrena, periostitis, periodontitis etc. )
7.Hotz serial extractio –primary canines
–primary first molars –permanent first premolars
1. Treatment with fixed appliances
- multiband, multibond
- lingual and palatinal arches
- Hyrax
2. Orthodontic treatment with extraction ( most frequently: first premolars )
reason: crowding or overjet
3. Orthodontic treatment with surgical intervention
f.e.: impacted teeth
4. Treatment with missing teeth
space closure or preprosthetic orthodontic treatment
-reason: aplasia, accidents, caries
5. Dysgnathia operations ( age: 18 )
progenia, prognathia, open bite
6. Orthodontic treatment in periodontal deseases
7. Problems with wisdom teeth